Drx for ANS

• ADRENALINE (EPINEPHRINE)

  hormone that is secreted mainly by the medulla of the adrenal glands and that functions primarily to increase cardiac output and to raise glucose levels in the blood.
• what structure is this?

  Epinephrine

  
• Epinephrine:SYMPTOMS

  ● systolic and diastolic blood pressure rise sharply;

  ● venous pressure also rises.

  ● Cerebrovascular or other haemorrhages and hemiplegia may result, especially in elderly patients.

  ● Pulmonary edema may occur.

  ● transient bradycardia followed by tachycardia

  ● Kidney failure

  ● Metabolic acidosis

  ● Cold white skin
• Epinephrine: TREATMENT Acute toxicity - Mainly supportive
• Counteract the pressor effect of Adrenaline

  • immediate IV injection of a quick-acting alpha-adrenoreceptor blocking agent (e.g. 5-10 mg of phentolamine mesylate)
  • followed by a beta-adrenoreceptor blocking agent (e.g. 2.5 - 5 mg of propranolol)
• Arrhythmias - Propranolol injection
• EPHEDRINE

  is a central nervous system stimulant used to treat breathing problems (as a bronchodilator), nasal congestion (as a decongestant), low blood pressure problems (orthostatic hypotension), or myasthenia gravis.
• Toxicodynamic

  • Ephedrine can produce stimulation at the adrenergic receptors and neuronal norepinephrine release
• What structure is this?

  EPhedrine

  
• Ephedrine: SYMPTOMS (ACUTE)

  INGESTION

  Early clinical manifestations of ingestion of high doses of ephedrine consist of

  ● nausea

  ● vomiting,

  2. followed by

  ● insomnia,

  ● cardiac arrhythmia,

  ● myocardial ischemia,

  ● agitation,

  ● psychosis and

  ● seizures.
• Ephedrine: PARENTERAL EXPOSURE

  ● intracerebral haemorrhage as a result of a rise in arterial pressure.

  ● Ventricular arrhythmias
• Ephedrine: SYMPTOMS (CHRONIC)

  INGESTION & PARENTERAL

  1. Neurological symptoms

  ● headache,

  ● anxiety,

  ● tremor,

  ● insomnia,

  ● dizziness,

  ● seizures .

  2. Psychosis

  3. Cardiovascular disorders

  ● chest pain,

  ● hypertension,

  ● arrhythmia,

  ● myocardial infarction,

  ● cerebral vascilitis and

  ● stroke
• Ephedrine: SKIN EXPOSURE

  ● Contact dermatitis
• Ephedrine: TOPICAL (as Nasal Spray)

  ● Local ischaemia
• Ephedrine: MANAGEMENT

  1.Give first aid.

  2. If breathing stops, open the airway and give mouth-to-mouth respiration.

  3. Give heart massage if the heart stops.

  4. Take the patient to hospital as quickly as possible.
• Ephedrine:

  If the patient is unconscious or drowsy,

  1.lay him or her on one side in the recovery position, and

  2. check breathing every 10 minutes.
• Ephedrine:

  If the patient has fever,

  1. sponge the body with cool water.
• Ephedrine:

  A patient who is anxious, confused, very restless, or aggressive, or who has hallucinations,

  1.should be kept in a quiet, dimly lit place and

  2. protect from injury.

  3. Stay calm and quiet yourself to reassure the patient.
• Ephedrine:

  If the substance was swallowed:

  If it was taken less than 4 hours ago (6 hours for atropine, 12 hours for sustained-release amfetamines) and if the patient is fully awake and breathing normally, and has not had fits:

  1. Make the patient vomit unless he or she has already vomited a lot. This should be done even if the patient has taken medicine to stop travel sickness, because these medicines do not usually stop vomiting caused by ipecacuanha or touching the throat. If you give the patient ipecacuanha but this does not cause vomiting, do not give another dose.
• Ephedrine:

  If the patient is fully awake

  1.give repeated doses of activated charcoal and water to drink.

  2. If you have made the patient vomit, wait until vomiting has stopped.

  Dose: adults, 50 g every 2-4 hours; children, 10-30 g every 2-4 hours. With each dose of charcoal give sodium sulfate or magnesium sulfate, 30 g to adults, 250 mg/kg of body weight to children, until the stools look black.
• Ephedrine Antidote:

  Activated Charcoal

  Adult dose: 50g every 2-4 hours

  Children Dose: 10-30g every 2-4 hours
• AMPHETAMINE

  psychostimulant drugs, which means they speed up the messages travelling between the brain and the body

  Some types of amphetamines are legally prescribed by doctors to treat conditions

  1.attention deficit hyperactivity disorder (ADHD)

  2. narcolepsy (where a person has an uncontrollable urge to sleep).

  3. Parkinson’s disease.
• • Other types of amphetamines such as speed are produced and sold illegally
• • The most potent form is crystal methamphetamine (ice)
• Amphetamine


  What structure is this?

  
• Amphetamine: CLINICAL MANIFESTATIONS

  CENTRAL NERVOUS SYSTEM

  ● Change of mental status, disorientation, and headache

  ● Dyskinesias

  ● Agitation

  ● Formication

  ● Symptoms of stroke
• Amphetamine: CLINICAL MANIFESTATIONS

  CARDIOVASCULAR

  ● Chest pain

  ● Palpitations
• Amphetamine: CLINICAL MANIFESTATIONS

  GASTROINTESTINAL

  ● Dry mouth

  ● Nausea and vomiting

  ● Diarrhea
• Amphetamine: CLINICAL MANIFESTATIONS

  SKIN / CUTANEOUS

  ● Diaphoresis

  ● Erythematous painful rashes, needle marks

  ● Infected deep ulcerations (ecthyma)
• Amphetamine: CLINICAL MANIFESTATIONS

  GENITOURINARY

  ● difficult micturition
• Amphetamine: EMERGENCY & SUPPORTIVE MEASURES

  1.Maintain patent airway and assist ventilation, if necessary

  2. Rapidly lower the body temperature (see Hyperthermia) in patients who are hyperthermic (39–40°C)

  3. Give intravenous fluids to prevent myoglobinuric kidney injury in patients who have rhabdomyolysis
• Amphetamine: ANTIDOTE

  LOCAL ANTIDOTE Activated charcoal

  SYSTEMIC ANTIDOTE Chlorpromazine, 1mg/kg IM or IV, may be repeated in 15min; reduced to 0.5mg/kg if other CNS depressants involved